Provider Demographics
NPI:1245257930
Name:LEON G LOME MD SC
Entity type:Organization
Organization Name:LEON G LOME MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEON
Authorized Official - Middle Name:GERSHON
Authorized Official - Last Name:LOME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:844-328-8884
Mailing Address - Street 1:800 AUSTIN ST
Mailing Address - Street 2:STE 569 EAST TOWER
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3439
Mailing Address - Country:US
Mailing Address - Phone:847-328-8884
Mailing Address - Fax:847-328-9129
Practice Address - Street 1:800 AUSTIN ST
Practice Address - Street 2:STE 569 EAST TOWER
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3439
Practice Address - Country:US
Practice Address - Phone:847-328-8884
Practice Address - Fax:847-328-9129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208800000X, 208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL340940Medicare PIN